of August 11, 2020 No. KR DSM-96/2020
About approval of Health regulations "Sanitary and epidemiologic requirements to health care facilities"
1. Approve the enclosed Health regulations "Sanitary and epidemiologic requirements to health care facilities".
3. To provide to committee of quality control and safety of goods and services of the Ministry of Health of the Republic of Kazakhstan in the procedure established by the legislation of the Republic of Kazakhstan:
1) state registration of this order in the Ministry of Justice of the Republic of Kazakhstan;
2) placement of this order on Internet resource of the Ministry of Health of the Republic of Kazakhstan;
3) within ten working days after state registration of this order in the Ministry of Justice of the Republic of Kazakhstan submission to Legal department of the Ministry of Health of the Republic of Kazakhstan of data on execution of the actions provided by subitems 1) and 2) of this Item.
4. To impose control of execution of this order on the vice-Minister of Health of the Republic of Kazakhstan Byurabekova L. V.
Minister of Health of the Republic of Kazakhstan
Committee on cases of construction and housing and communal services of the Ministry of the industry and infrastructure development of the Republic of Kazakhstan
No. KR DSM-96/2020 are approved by the Order of the Minister of Health of the Republic of Kazakhstan of August 11, 2020
1. These Health regulations "Sanitary and epidemiologic requirements to health care facilities" (further - Health regulations) establish sanitary and epidemiologic requirements to health care facilities.
2. Health regulations contain sanitary and epidemiologic requirements to:
1) to the choice of the parcel of land under construction and to designing of health care facilities;
2) to water supply and water disposal of health care facilities;
3) to lighting, ventilation, conditioning and heat supply of health care facilities;
4) to repair and content of rooms of health care facilities;
5) to the organization and holding sanitary and anti-epidemic and sanitary and preventive actions on health care facilities;
6) to collection, neutralization, storage of medical waste on health care facilities;
7) to food conditions on health care facilities;
8) to working conditions and consumer services of personnel;
9) requirements to the organization and holding sanitary and anti-epidemic actions for localization of the centers of infection.
3. In these Health regulations the following concepts are used:
1) medical waste of class "A" - not differing on structure from household waste, not having dangerous properties;
2) antiseptics - the chemical antimicrobic agent intended for application on skin or fabric for the purpose of destruction of microbes;
3) aseptic department - rooms for delivery of health care in case of absence at the patient of purulent infection;
4) the aseptic mode - complex of the sanitary and sanitary and hygienic actions preventing hit of microbes in wound;
5) medical waste of class "B" - epidemiologically dangerous medical wastes (infected and potentially infected waste. The materials and tools, objects polluted by blood and other biological liquids. Pathoanatomical waste, organic operational waste (bodies, fabrics). Food wastes from infectious departments. Waste from microbiological, kliniko-diagnostic laboratories, the pharmaceutical, immunobiological productions working with microorganisms of the III-IV groups of pathogenicity. Biological waste of vivariums. Live vaccines unsuitable to use;
6) the box - the room having separate entrance for arrival of the patient from the outside. Are its part: chamber, bathroom, bathtub and lock;
7) medical waste of class "B" - extremely epidemiologically dangerous medical wastes (the materials contacting to sick especially dangerous and quarantine infectious diseases which can lead to origin extraordinary situations in the sphere of sanitary and epidemiologic wellbeing of the population and require holding actions for sanitary protection of the territory. Waste of laboratories, the pharmaceutical and immunobiological productions working with microorganisms of the I-II groups of pathogenicity. Waste from patients with anaerobic infection and from TB patients. Waste of the microbiological laboratories which are carrying out work with causative agents of tuberculosis);
8) medical waste of class "G" - toxicological dangerous medical wastes (medicinal, including cytostatics, diagnostic, the disinfectants which are not subject to use. Mercury-containing objects, devices and equipment. Waste of raw materials and products of pharmaceutical productions. Waste from operation of the equipment, transport, systems of lighting);
9) medical waste of class "D" - the radioactive medical waste (containing radioactive materials in quantity and concentration which exceed the values regulated for radioactive materials established by the legislation of the Republic of Kazakhstan in the field of use of atomic energy);
10) health care facilities - objects on which perform the organization activity of health care and physical persons practising medicine in the field of health care;
11) the organization of health care - the legal entity performing activities in the field of health care;
12) individual maternity chamber or chamber of joint stay - the equipped room with bathroom for carrying out childbirth for one woman in labor in whom the woman in childbirth with the newborn are to the statement from hospital;
13) individual protection equipment (further - SIZ) - the means used by the worker for prevention or reduction of impact of harmful and dangerous production factors and also for protection against pollution;
14) portable medical object - the mobile consulting and diagnostic object placed based on vehicles (automobile, railway, sea, river, aviation) with the equipment and places for medical personnel;
15) medical waste - the waste which is formed in the course of rendering medical services and carrying out medical manipulations;
16) neutralization of medical waste - reduction or elimination of dangerous properties of waste by mechanical, physical and chemical or biological processing;
17) special installation on neutralization of medical waste - the specialized processing equipment intended for neutralization of medical waste, using burning, autoclaving, microwave processing, plasma processing and other methods of neutralization;
18) container for safe collection and utilization of medical waste (further - KBSU) - the waterproof and not punctured disposable reservoirs for collection and safe utilization of the sharp and pricking medical waste;
19) sanitary clothes - production clothes for protection of objects of the labor from working and working from general production pollution;
20) the sanitary and anti-epidemic mode - complex of actions for the prevention and not distribution on health care facilities of infectious and parasitic diseases;
21) the selitebny territory - the part of the territory of the settlement intended for placement of residential, public (public and business) and recreational zones, and also separate parts of engineering and transport infrastructures, other objects which placement and activities does not make the impact requiring special sanitary protection zones;
22) lock - part of the room between chamber, department and general corridor, eliminating possibility of penetration of air from one room in another by means of ventilating system and placed between rooms with various levels of air pollution.
4. The choice of the parcel of land under construction, designing of health care facilities is determined by design assignment according to requirements of the state standard rates in the field of architecture, town planning and construction, according to subitem 23-16) of article 20 of the Law of the Republic of Kazakhstan of July 16, 2001 "About architectural, town-planning and construction activities in the Republic of Kazakhstan" (further - the state standard rates in the field of architecture, town planning and construction).
5. During the designing and construction of pre-fabricated modular hospitals in the period of epidemics, pandemics it is necessary to be guided by provisions of the corresponding state standard rates in the field of architecture, town planning and construction.
6. During the designing of infectious diseases hospitals, department are provided:
1) reception where it is necessary to have at least two viewing offices or boxes;
2) the isolated departments for hospitalization of patients with airborne, intestinal, viral infections, especially dangerous and quarantine infections;
3) diagnostic department (diagnostic chambers);
7. When designing in the viewing box of infectious diseases hospital the independent isolated external entrance is provided.
8. When designing the perinatal centers, maternity hospitals it is necessary to provide postnatal chambers with a capacity no more than two maternal beds. In the perinatal center departments for holding resuscitation actions and intensive therapy by the newborn are provided.
9. The structure and the areas of departments of extracorporal fertilization is determined by engineering procedure and capacity of organization.
10. In case of arrangement of operating rooms one above another septic operating rooms are placed above aseptic.
Operational blocks (departments) are provided chanceless. Entrance for medical personnel propusknik, for patients through locks are provided through sanitary.
11. Aseptic departments (blocks) include: chambers with toilet, bathroom or shower, procedural, office of the doctor, the room of storage of sterile material and other rooms depending on profile of department.
12. Sanitary propusknik for personnel are designed as a part of three adjacent rooms. The first room is equipped with shower, the bathroom. The second room is used for putting on of net surgical suits, footwear, boot covers. The third room is intended for change and collection of the used linen.
13. In the centers of out-patient, plastic and esthetic surgery, dermato-cosmetology objects, the out-patient and polyclinic organizations, Small operational Halls with the minimum set of rooms - the operating room, preoperative, sanitary propusknik, lock are provided in case of entrance to the operating room for patients and postoperative chamber. The sanitary propusknik is designed as a part of one room which is equipped with shower with providing conditions for storage net and collection of dirty linen of personnel.
To Small operational Halls the patient arrives through lock, personnel - through preoperative.
14. The tubercular organizations are placed in residential suburb or suburban areas, whenever possible in green massifs, with observance of gaps from the selitebny territory.
15. The structure and the areas of the main and auxiliary rooms of health care facilities are determined according to the state standard rates in the field of architecture, town planning and construction.
16. In residential buildings placement of health care facilities no more than 100 visits per shift giving out-patient and polyclinic help capacity, including with day hospitals, the centers of out-patient surgery (stay of patients no more than 5 days), in the presence of separate entrance is allowed.
17. Placement in the residential building of hospitals with the round-the-clock stay of patients, except as specified, of stipulated in Item 15 these Health regulations is not allowed.
18. Operational, dressing, procedural, handling, patrimonial, dental offices, reception and ward departments for patients are not placed in ground and basement stores of buildings.
Placement in ground and basement stores of buildings of the room and offices of recovery treatment (halls of medical physical culture, medical pools, rooms of balneotherapy, massage offices), and also electro-phototherapy offices, on condition of the organization of natural lighting is allowed.
19. On health care facilities centralized economic and drinking, hot water supply and water disposal are provided.
20. In the absence of centralized system of water supply on health care facility water from not centralized sources of water supply (well) or the imported water corresponding to documents of regulation is used. Supply of water is performed by the special vehicle. Storage of water is performed in the special marked reservoirs.
21. Installation of sinks with eyeliner of cold and hot water is provided in all offices of acceptance of doctors, chambers, auxiliary rooms (the room of personnel, matron, collection of dirty linen, sanitary rooms, bathrooms).
The preoperative, dressing, procedural, handling, inoculative offices, resuscitation halls and chambers, patrimonial halls, locks of boxes, semi-boxes, posts of nurses under chambers of newborns requiring particular treatment should be equipped with sinks with eyeliner of cold and hot water with installation of elbow and contactless cranes with mixers.
22. In the absence of centralized hot water supply in preoperative and patrimonial halls, handling, procedural, dressing, inoculative offices, sterilizing, resuscitation and departments of newborns and children up to one year, receptions, sanitary and household rooms, washing, buffets, distributing, catering departments, laundries water heaters of continuous action are established.
23. In case of placement of object in not having or partially centralized network of water disposal settlements the device of local system of water disposal is provided. Acceptance of sewage is performed in underground waterproof reservoir. Reservoir for acceptance of sewage is equipped with cover, is placed in economic zone and is cleared in process of filling.
24. Natural and artificial illumination of rooms of health care facilities is determined by parameters according to appendix 1 to these Health regulations.
25. Optimum conditions of microclimate and the air circle in rooms of health care facilities are provided with systems of ventilation, conditioning and heating. Forced-air and exhaust systems of ventilation serve groups of rooms according to purity class.
26. Buildings of health care facilities in which appear the stationary and out-patient and polyclinic help expected 150 and more visits per shift should be equipped with systems of supply and exhaust ventilation with mechanical motivation.
For health care facilities less than 150 visits per shift are provided installation of devices of air conditioning with bactericidal filters in aseptic rooms.
In infectious hospitals (departments), including in antitubercular, in each boxing and semi-boxing in ward section the separate exhaust system of ventilation with gravitational motivation is installed.
27. The air given to operational, narcotic, patrimonial, resuscitation, postoperative chambers, chambers of intensive therapy, to chambers for patients with burns of skin and oncohematological patients with immunodeficiency is disinfected by means of bactericidal air filters with high extent of cleaning (at least 95%). In operating rooms, chambers of intensive therapy, resuscitation, patrimonial, procedural, laboratories, rooms in which operation of the medical equipment is followed by allocation in air of hazardous substances, the device of local suctions or installation of fume cupboards is provided.
28. Frequency rate of air exchange is chosen proceeding from calculations of ensuring the set purity and maintenance of gas composition of air. Relative humidity of air no more than 60%, speed of movement of air of no more 0,15 of meters per second.
29. Air ducts, lattices, air-ventilation chambers are kept clean, without mechanical damages, traces of corrosion, hermeticity violation. Internal surface of air ducts of supply and exhaust ventilation (conditioning) exclude carrying out to rooms of particles of material of air duct, protective coating and it is made of the materials which do not have the occluding properties.
30. The equipment of systems of ventilation is placed in special rooms, separate for stitched and exhaust systems.
Placement of studies, operating rooms, chambers, rooms with permanent stay of the people adjoining on vertical and horizontal technical rooms of systems of ventilation on condition of accomplishment of actions for isolation of noise and vibration is allowed.
31. In rooms the exhaust ventilation with single air exchange, forced ventilation with twofold air exchange is established.
32. In aseptic rooms the hidden laying of air ducts, pipelines, armature is performed.
33. On the health care facilities giving stationary help and the out-patient and polyclinic help by capacity of 150 and more visits per shift, the exhaust ventilation with mechanical motivation without device of organized inflow is equipped in shower, toilets, sanitary rooms, rooms for dirty linen, temporary storage of waste and storage rooms for disinfectants.
34. In the antitubercular organizations (departments):
1) the system of ventilation shall provide at least sixfold air exchange in hour in chambers and twelvefold in rooms for accomplishment of aerozolyobrazuyushchy procedures (the room of collection of phlegm, bronkhoskopiya), with the balanced giving, without allowing emergence of stagnant zones;
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